Q: I'm confused about all these new tests I've been hearing about for cervical
cancer screening. Are they instead of the Pap smear or in addition to it?

Dr. Donnica: There are currently several categories of new diagnostic
techniques that aim to improve the quality of Pap smear results: those that
use computer enhanced technology to better view the smear; those that improve
the quality of the smear preparation itself; those that actually can diagnose
HPV (the causative agent of most cervical cancer); and those that automate several
of the tedious portions of slide processing that make it easier for cytotechnologists
(the person who actually reads the Pap smears) to do their jobs. All of these
tests are in addition to the traditional Pap smear at this point- not instead
of it. The only downside to these tests is that of additional cost; many insurance
carriers are not yet reimbursing for them, although this is changing rapidly.
Despite the additional cost per test, insurers are recognizing the potential
cost savings as they may reduce the need for repeat tests, repeat doctors' visits,
cervical biopsies, and needless anxiety. For most women, these new tests are
nice to have, but are probably not necessary. Unfortunately, many women who
could potentially benefit most from these technologies have their access to
them most limited by financial obstacles. Remember, the most important thing
for most women is to have your Pap smear done annually (or more frequently if
recommended by your physician). In this way, we can make the goal of eliminating
cervical cancer deaths in the 21st century a reality.

Specific New Tests:

AutoPap®, PapNet®:

These are computerized screening/rescreening devices that can be run non-stop
and which are reported to be more accurate at picking up cellular abnormalities
than technologists. Currently they are used mostly as "back-up" ("rescreening")
to traditional screening, as a computerized second opinion to catch "false-negatives",
those tests which were reported as "normal" but which actually contained abnormal
cells. The idea of computers rather than trained cytotechnologists reviewing
Pap smears is a novel one--and for some, an uncomfortable one--in the US.
But in other countries such as Japan, this practice is now standard. The added
cost--rather than its added accuracy--seems to be the focus of most objections
thus far. As with most newly introduced medical technologies, this should
become less of an issue over time.

Thin Prep®:

This test addresses the challenges of proper sample
collection. It is a thin layer liquid-based preparation that allows the entire
sample to be collected and then viewed more completely in its entirety. Its
use decreases the need for repeat exams due to inadequate sampling. The process
is more sensitive and specific than a traditional Pap smear; it reduces false
negative test results considerably. The FDA has called ThinPrep "significantly
more effective" than the standard Pap.

HPV Testing:

A study in JAMA suggests that home HPV testing may detect more cervical
disease than an in-office Pap smear. While this test is not yet available to consumers,
the hope is that once it is, it will greatly increase access to cervical screening
and play a major role in preventing cervical cancer. There is currently an FDA-approved
HPV DNA test available to physicians as an adjunct to the Pap smear. This test
can accurately identify whether a woman with HPV is affected by one of the 13
key cancer causing HPV types.

Created: 9/24/2000&nbsp - Donnica Moore, M.D.

Unfortunately, many women who could potentially benefit most from these technologies have their access to them most limited by financial obstacles.